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Arthroskopie

, Volume 29, Issue 2, pp 82–88 | Cite as

Einfluss lokaler Anästhetika auf den hyalinen Gelenkknorpel

  • P. AngeleEmail author
  • J. ZellnerEmail author
Leitthema

Zusammenfassung

Einleitung

Die Zytotoxizität von lokalen Schmerztherapeutika auf den Gelenkknorpel ist insbesondere bei der Anwendung von kontinuierlichen Schmerzpumpen erkennbar. Hierbei kann es zum Auftreten von Chondrolysen kommen.

Methoden

Insbesondere Bupivacain, aber auch Mepivacain, Ropivacain und Lidocain zeigten im Rahmen von In-vitro- und In-vivo-Studien Toxizität am Gelenkknorpel.

Ergebnisse

Ob eine einmalige intraartikuläre Injektion ausreicht, Apoptose am Gelenkknorpel auszulösen, ist unklar. Allerdings zeigen die bisherigen Dosisfindungsstudien, dass eine zunehmende Konzentration und Einwirkzeit der Lokalanästhetika auf den Gelenkknorpel zu einem progredienten Zellschaden führen. Da die Studien mit unterschiedlichen Zellen, Kultursystemen und Tiermodellen arbeiten, sind die Ergebnisse z. T. divergent und Schwellenwerte auf den Einsatz im klinischen Alltag beim Menschen nur schwer zu übertragen.

Schlussfolgerung

Bei der bisherigen Datenlage muss die Indikation zur intraartikulären Injektion lokaler Anästhetika streng überprüft werden. Auf Pumpensysteme zur kontinuierlichen intraartikulären Applikation sollte komplett verzichtet werden.

Schlüsselwörter

Lokalanästhetika Toxische Nebenwirkungen Zytotoxizität Schmerzpumpensystem Chondrolyse 

Influence of local anesthetic agents on articular hyaline cartilage

Abstract

Background

The cytotoxicity of local anesthetics on articular hyaline cartilage is particularly noticeable in the use of continuous infusion pain pumps. This can result in the onset of chondrolysis.

Methods

Bupivacaine in particular but also mepivacaine, ropivacaine and lidocaine, have shown cytotoxic effects on hyaline cartilage in multiple in vitro and in vivo studies.

Results

Whether a single intra-articular administration of local anesthetics is sufficient to result in apoptosis of articular hyaline cartilage is unclear; however, the currently published dose response studies revealed that increasing concentrations and contact times of local anesthetics result in progressive cell damage to articular cartilage. The studies used different cell and culture systems as well as different animal models; therefore, the results are partly divergent and it is difficult to extrapolate the threshold levels of cytotoxic concentrations to the routine clinical practice.

Conclusion

According to the currently available data, the indications for intra-articular injection of local anesthetics should be interpreted with caution. Intra-articular administration via continuous infusion pain pumps should no longer be used.

Keywords

Local anesthetics Toxic side effects Cytotoxicity Infusion pumps Chondrolysis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Angele und J. Zellner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Klinik für UnfallchirurgieUniversitätsklinikum RegensburgRegensburgDeutschland
  2. 2.sporthopaedicum RegensburgRegensburgDeutschland

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